DOCSLIB.ORG

Bradycardia (Symptomatic)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bradycardia (Symptomatic) San Mateo County Emergency Medical Services Bradycardia (Symptomatic) History Signs and Symptoms Differential • Past medical history • Heart rate < 50 with associated hypotension, acute • Acute myocardial infarction • Heart transplant altered mental status, chest pain, acute CHF, • Hypoxia • Medications seizures, syncope or shock secondary to • Pacemaker failure • Beta blockers bradycardia • Hypothermia • Calcium channel blockers • Systolic BP < 90 • Sinus bradycardia • Clonidine • Chest pain • Athletes • Digoxin • Respiratory distress • Head injury (elevated ICP) or stroke • Pacemaker • Hypotension or shock • Spinal cord lesion • Altered mental status • Sick sinus syndrome • Syncope • AV blocks (e.g., 1o, 2o or 3o) • Overdose HR < 50 and symptomatic: Exit to Hypotension, acute AMS, chest pain, acute CHF, No appropriate TP seizure, syncope, or shock secondary to bradycardia Yes Cardiac monitor P Establish IV/IO 12-Lead ECG Atropine If systolic BP < 90 Normal Saline bolus 500ml IV/IO Maximum 2L Transcutaneous pacing Consider amnestic properties P if not responsive to Atropine. Pacing may be Midazolam considered first line therapy for severe P Consider pain control symptoms. Fentanyl Consider early in 2o or 3o blocks and patients with suspected cardiac ischemia EtCO2 monitoring (if available) Dopamine Respiratory Distress or Airway Field Dyspnea/increased work of breathing, Yes Procedure especially with hypoxia? if indicated Notify receiving facility. Consider Base Hospital for medical direction Treatment Protocol CD01 Page 1 of 2 EffectiveEffective November March 2018 2019 San Mateo County Emergency Medical Services Bradycardia (Symptomatic) Pearls • Bradycardia causing symptoms is typically < 50/minutes. Rhythm should be interpreted in the context of symptoms and pharmacological treatment given only when symptomatic, otherwise monitor and reassess frequently. • Identifying signs and symptoms of poor perfusion caused by bradycardia is paramount. • Atropine vs. pacing: Caution should be exercised in the setting of a suspected acute MI. The use of Atropine for bradycardia in the presence of an acute MI may worsen heart damage. Providers should NOT DELAY transcutaneous pacing for patients with poor perfusion in the setting of an acute MI or 2o or 3o heart block. • For patients who are not in 2o or 3o heart block, pacing may be considered for bradycardia not responsive to Atropine. Prepare to utilize transcutaneous pacing early if the patient does not respond to Atropine. • For wide complex, bizarre appearance of QRS complexes with slow rhythm, consider hyperkalemia. • Consider treatable causes for bradycardia (e.g., beta blocker OD, calcium channel blocker OD, etc.) • Hypoxemia is a common cause of bradycardia. Be sure to oxygenate the patient and support respiratory effort. • Sinus bradycardia in the absence of key symptoms requires no specific treatment; monitor and observe. • Sinus bradycardia is often seen in patients with STEMI or ischemia. An early 12-Lead ECG should be obtained to assess for STEMI. • A fluid bolus may address hypotension and lessen the need for pacing or treatment with Atropine. • Sedation prior to starting pacing is not required. Patients with urgent needs should be paced first and sedated afterwards. • The objective of amnesia and pain control with pacing is to decrease discomfort, not to decrease level of consciousness. Patients who are in need of pacing are unstable and medications should be used with extreme caution. • Monitor respiratory status closely and support ventilation as necessary. • Atropine is not effective for bradycardia in heart transplant patients as there is no vagus nerve innervation in these patients. • Patients with wide QRS or 2o or 3o heart blocks will not have a response to Atropine because their heart rates are not based on vagal tone. An increase in ventricular arrhythmias may occur. • If no capture or hypotensive (SBP<90), then start dopamine 5 mcg/kg/min. If inadequate response after 5 minutes, then may increase 5 mcg/kg/min to a maximum dose of 20 mcg/kg/min. Treatment Protocol CD01 Page 2 of 2 EffectiveEffective November March 2018 2019.
Load more

Recommended publications
  • Guidelines on the Diagnosis and Management of Pericardial
    European Heart Journal (2004) Ã, 1–28 ESC Guidelines Guidelines on the Diagnosis and Management of Pericardial Diseases Full Text The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology Task Force members, Bernhard Maisch, Chairperson* (Germany), Petar M. Seferovic (Serbia and Montenegro), Arsen D. Ristic (Serbia and Montenegro), Raimund Erbel (Germany), Reiner Rienmuller€ (Austria), Yehuda Adler (Israel), Witold Z. Tomkowski (Poland), Gaetano Thiene (Italy), Magdi H. Yacoub (UK) ESC Committee for Practice Guidelines (CPG), Silvia G. Priori (Chairperson) (Italy), Maria Angeles Alonso Garcia (Spain), Jean-Jacques Blanc (France), Andrzej Budaj (Poland), Martin Cowie (UK), Veronica Dean (France), Jaap Deckers (The Netherlands), Enrique Fernandez Burgos (Spain), John Lekakis (Greece), Bertil Lindahl (Sweden), Gianfranco Mazzotta (Italy), Joa~o Morais (Portugal), Ali Oto (Turkey), Otto A. Smiseth (Norway) Document Reviewers, Gianfranco Mazzotta, CPG Review Coordinator (Italy), Jean Acar (France), Eloisa Arbustini (Italy), Anton E. Becker (The Netherlands), Giacomo Chiaranda (Italy), Yonathan Hasin (Israel), Rolf Jenni (Switzerland), Werner Klein (Austria), Irene Lang (Austria), Thomas F. Luscher€ (Switzerland), Fausto J. Pinto (Portugal), Ralph Shabetai (USA), Maarten L. Simoons (The Netherlands), Jordi Soler Soler (Spain), David H. Spodick (USA) Table of contents Constrictive pericarditis . 9 Pericardial cysts . 13 Preamble . 2 Specific forms of pericarditis . 13 Introduction. 2 Viral pericarditis . 13 Aetiology and classification of pericardial disease. 2 Bacterial pericarditis . 14 Pericardial syndromes . ..................... 2 Tuberculous pericarditis . 14 Congenital defects of the pericardium . 2 Pericarditis in renal failure . 16 Acute pericarditis . 2 Autoreactive pericarditis and pericardial Chronic pericarditis . 6 involvement in systemic autoimmune Recurrent pericarditis . 6 diseases . 16 Pericardial effusion and cardiac tamponade .
    [Show full text]
  • Cardiac Involvement in COVID-19 Patients: a Contemporary Review
    Review Cardiac Involvement in COVID-19 Patients: A Contemporary Review Domenico Maria Carretta 1, Aline Maria Silva 2, Donato D’Agostino 2, Skender Topi 3, Roberto Lovero 4, Ioannis Alexandros Charitos 5,*, Angelika Elzbieta Wegierska 6, Monica Montagnani 7,† and Luigi Santacroce 6,*,† 1 AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Coronary Unit and Electrophysiology/Pacing Unit, Cardio-Thoracic Department, Policlinico University Hospital of Bari, 70124 Bari, Italy; [email protected] 2 AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Cardiac Surgery, Policlinico University Hospital of Bari, 70124 Bari, Italy; [email protected] (A.M.S.); [email protected] (D.D.) 3 Department of Clinical Disciplines, School of Technical Medical Sciences, University of Elbasan “A. Xhuvani”, 3001 Elbasan, Albania; [email protected] 4 AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Clinical Pathology Unit, Policlinico University Hospital of Bari, 70124 Bari, Italy; [email protected] 5 Emergency/Urgent Department, National Poisoning Center, Riuniti University Hospital of Foggia, 71122 Foggia, Italy 6 Department of Interdisciplinary Medicine, Microbiology and Virology Unit, University of Bari “Aldo Moro”, Piazza G. Cesare, 11, 70124 Bari, Italy; [email protected] 7 Department of Biomedical Sciences and Human Oncology—Section of Pharmacology, School of Medicine, University of Bari “Aldo Moro”, Policlinico University Hospital of Bari, p.zza G. Cesare 11, 70124 Bari, Italy; [email protected] * Correspondence: [email protected] (I.A.C.); [email protected] (L.S.) † These authors equally contributed as co-last authors. Citation: Carretta, D.M.; Silva, A.M.; D’Agostino, D.; Topi, S.; Lovero, R.; Charitos, I.A.; Wegierska, A.E.; Abstract: Background: The widely variable clinical manifestations of SARS-CoV2 disease (COVID-19) Montagnani, M.; Santacroce, L.
    [Show full text]
  • J Wave Syndromes
    Review Article http://dx.doi.org/10.4070/kcj.2016.46.5.601 Print ISSN 1738-5520 • On-line ISSN 1738-5555 Korean Circulation Journal J Wave Syndromes: History and Current Controversies Tong Liu, MD1, Jifeng Zheng, MD2, and Gan-Xin Yan, MD3,4 1Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 2Department of cardiology, The Second Hospital of Jiaxing, Jiaxing, China, 3Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, Pennsylvania, USA, 4The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, China The concept of J wave syndromes was first proposed in 2004 by Yan et al for a spectrum of electrocardiographic (ECG) manifestations of prominent J waves that are associated with a potential to predispose affected individuals to ventricular fibrillation (VF). Although the concept of J wave syndromes is widely used and accepted, there has been tremendous debate over the definition of J wave, its ionic and cellular basis and arrhythmogenic mechanism. In this review article, we attempted to discuss the history from which the concept of J wave syndromes (JWS) is evolved and current controversies in JWS. (Korean Circ J 2016;46(5):601-609) KEY WORDS: Brugada syndrome; Sudden cardiac death; Ventricular fibrillation. Introduction History of J wave and J wave syndromes The concept of J wave syndromes was first proposed in 2004 The J wave is a positive deflection seen at the end of the QRS by Yan et al.1) for a spectrum of electrocardiographic (ECG) complex; it may stand as a distinct “delta” wave following the QRS, manifestations of prominent J waves that are associated with a or be partially buried inside the QRS as QRS notching or slurring.
    [Show full text]
  • The Syndrome of Alternating Bradycardia and Tachycardia by D
    Br Heart J: first published as 10.1136/hrt.16.2.208 on 1 April 1954. Downloaded from THE SYNDROME OF ALTERNATING BRADYCARDIA AND TACHYCARDIA BY D. S. SHORT From the National Heart Hospita. Received September 15, 1953 Among the large number of patients suffering from syncopal attacks who attended the National Heart Hospital during a four-year period, there were four in whom examination revealed sinus bradycardia alternating with prolonged phases of auricular tachycardia. These patients presented a difficult problem in treatment. Each required at least one admission to hospital and in one case the symptoms were so intractable as to necessitate six admissions in five years. Two patients had mitral valve disease, one of them with left bundle branch block. One had aortic valve sclerosis while the fourth had no evidence of heart disease. THE HEART RATE The sinus rate usually lay between 30 and 50 a minute, a rate as slow as 22 a minute being observed in one patient (Table I). Sinus arrhythmia was noted in all four patients, wandering of TABLE I http://heart.bmj.com/ RATE IN SINus RHYTHM AND IN AURICULAR TACHYCARDIA Rate in Case Age Sex Associated Rate in auricular tachycardia heart disease sinus rhythm Auricular Venliicular 1 65 M Aortic valve sclerosis 28-48 220-250 60-120 2 47 F Mitral valve disease 35-75 180-130 90-180 on September 26, 2021 by guest. Protected copyright. 3 38 F Mitral valve disease 22-43 260 50-65 4 41 F None 35-45 270 110 the pacemaker in three, and periods of sinus standstill in two (Fig.
    [Show full text]
  • Chest Pain/Angina ­ Humanresearchwiki Chest Pain/Angina
    6/14/2016 Chest Pain/Angina ­ HumanResearchWiki Chest Pain/Angina From HumanResearchWiki Contents 1 Introduction 2 Clinical Priority and Clinical Priority Rationale by Design Reference Mission 3 Initial Treatment Steps During Space Flight 4 Capabilities Needed for Diagnosis 5 Capabilities Needed for Treatment 6 Associated Gap Reports 7 Other Pertinent Documents 8 List of Acronyms 9 References 10 Last Update Introduction Cardiac chest pain, also known as angina, usually occurs secondary to deprivation of oxygen from an area of the heart, often resulting from an inability of the coronary arteries to supply adequate amounts of oxygen during a time of increased demand. The most common cause is atheromatous plaque which obstructs the coronary arteries.[1] NASA crewmembers are extensively screened to rule out coronary artery disease, but progression of previously subclinical and undetectable coronary artery disease may occur during a long duration mission. The initial care of cardiac chest pain is available on the International Space Station (ISS) and the crew is trained to evaluate and treat as needed (ISS Medical Checklist).[2] Clinical Priority and Clinical Priority Rationale by Design Reference Mission One of the inherent properties of space flight is a limitation in available mass, power, and volume within the space craft. These limitations mandate prioritization of what medical equipment and consumables are manifested for the flight, and which medical conditions would be addressed. Therefore, clinical priorities have been assigned to describe which medical conditions will be allocated resources for diagnosis and treatment. “Shall” conditions are those for which diagnostic and treatment capability must be provided, due to a high likelihood of their occurrence and severe consequence if the condition were to occur and no treatment was available.
    [Show full text]
  • Basic Rhythm Recognition
    Electrocardiographic Interpretation Basic Rhythm Recognition William Brady, MD Department of Emergency Medicine Cardiac Rhythms Anatomy of a Rhythm Strip A Review of the Electrical System Intrinsic Pacemakers Cells These cells have property known as “Automaticity”— means they can spontaneously depolarize. Sinus Node Primary pacemaker Fires at a rate of 60-100 bpm AV Junction Fires at a rate of 40-60 bpm Ventricular (Purkinje Fibers) Less than 40 bpm What’s Normal P Wave Atrial Depolarization PR Interval (Normal 0.12-0.20) Beginning of the P to onset of QRS QRS Ventricular Depolarization QRS Interval (Normal <0.10) Period (or length of time) it takes for the ventricles to depolarize The Key to Success… …A systematic approach! Rate Rhythm P Waves PR Interval P and QRS Correlation QRS Rate Pacemaker A rather ill patient……… Very apparent inferolateral STEMI……with less apparent complete heart block RATE . Fast vs Slow . QRS Width Narrow QRS Wide QRS Narrow QRS Wide QRS Tachycardia Tachycardia Bradycardia Bradycardia Regular Irregular Regular Irregular Sinus Brady Idioventricular A-Fib / Flutter Bradycardia w/ BBB Sinus Tach A-Fib VT PVT Junctional 2 AVB / II PSVT A-Flutter SVT aberrant A-Fib 1 AVB 3 AVB A-Flutter MAT 2 AVB / I or II PAT PAT 3 AVB ST PAC / PVC Stability Hypotension / hypoperfusion Altered mental status Chest pain – Coronary ischemic Dyspnea – Pulmonary edema Sinus Rhythm Sinus Rhythm P Wave PR Interval QRS Rate Rhythm Pacemaker Comment . Before . Constant, . Rate 60-100 . Regular . SA Node Upright in each QRS regular . Interval =/< leads I, II, . Look . Interval .12- .10 & III alike .20 Conduction Image reference: Cardionetics/ http://www.cardionetics.com/docs/healthcr/ecg/arrhy/0100_bd.htm Sinus Pause A delay of activation within the atria for a period between 1.7 and 3 seconds A palpitation is likely to be felt by the patient as the sinus beat following the pause may be a heavy beat.
    [Show full text]
  • Case Report: Cytarabine-Induced Pericarditis and Pericardial Effusion Rino Sato, MD and Robert Park, MD
    HEMATOLOGY & ONCOLOGY Case Report: Cytarabine-Induced Pericarditis and Pericardial Effusion Rino Sato, MD and Robert Park, MD INTRODUCTION for inpatient chemotherapy, and demonstrated mild global left ventricular dysfunction with ejection fraction Cytarabine (cytosine arabinoside, Ara-C) is an antime- of 40%. The cardiomyopathy was attributed to his tabolite analogue of cytidine that is used as a chemo- underlying hypertension or sleep apnea, and not therapeutic agent for the treatment of acute myelogenous coronary artery disease based on a normal coronary leukemia and lymphocytic leukemias1 . The most computed tomography (CT) angiogram. The patient common side effects of this therapy include myelosup- was started on induction therapy with high-dose pression, pancytopenia, hepatotoxicity, gastrointestinal cytarabine therapy at 3g/m2 every twelve hours without ulceration with bleeding, and pulmonary infiltrates2. an anthracycline agent such as doxorubicin. Cardio-pulmonary complications of cytarabine therapy are uncommon, but include supraventricular and On day 5 of cytarabine therapy, the patient developed ventricular arrhythmias, sinus bradycardia, and recurrent non-radiating sharp chest pain that worsened with heart failure2, 3. Occasionally, patients may develop inspiration and palpation. He had no cough or sputum pericarditis leading to pericardial tamponade, which can production. His cardiac exam revealed a tri-phasic, be fatal. We report a case of cytarabine-induced high-pitched friction rub best heard over the left lower pericarditis and pericardial effusion to increase awareness sternal border. He was normotensive, did not have pulsus about this serious side effect of cytarabine and review paradoxus, and had minimally distended jugular veins. the current literature. An electrocardiogram revealed widespread concave ST-elevation and PR-depression in the limb leads (I, II, III, CASE PRESENTATION avF) and precordial leads (V5-V6) concerning for acute pericarditis (Figure 1).
    [Show full text]
  • Shortness of Breath. History of the Present Illness
    10/20/2006 Write-Up to be Graded Sarah Broom Chief Complaint: Shortness of breath. History of the Present Illness: Mr.--- is a previously healthy 56-year-old gentleman who presents with a four day history of shortness of breath, hemoptysis, and right-sided chest pain. He works as a truck driver, and the symptoms began four days prior to admission, while he was in Jackson, MS. He drove from Jackson to Abilene, TX, the day after the symptoms began, where worsening of his dyspnea and pain prompted him to go to the emergency room. There, he was diagnosed with pneumonia and placed on Levaquin 500 mg daily and Benzonatate 200 mg TID, which he has been taking for two days with only slight improvement. He then drove from Abilene back to Greensboro, where he resides, and continued to experience shortness of breath, right sided chest pain, and hemoptysis. He presented to an urgent care office in town today, and was subsequently transferred to the Moses Cone ER due to the provider’s suspicion of PE. The right-sided pain is located midway down his ribcage, below the axilla. This pain is sharp, about 7/10 in severity, and worsens with movement and cough. Pressing on the chest does not recreate the pain. He feels that the pain has improved somewhat over the past two days. The hemoptysis has been unchanged since it began; there is not frank blood, but his sputum has been consistently blood-tinged. The blood seems redder at night. The dyspnea has been severe, and it is difficult for him to walk more than across a room.
    [Show full text]
  • Basic Cardiac Rhythms – Identification and Response Module 1 ANATOMY, PHYSIOLOGY, & ELECTRICAL CONDUCTION Objectives
    Basic Cardiac Rhythms – Identification and Response Module 1 ANATOMY, PHYSIOLOGY, & ELECTRICAL CONDUCTION Objectives ▪ Describe the normal cardiac anatomy and physiology and normal electrical conduction through the heart. ▪ Identify and relate waveforms to the cardiac cycle. Cardiac Anatomy ▪ 2 upper chambers ▪ Right and left atria ▪ 2 lower chambers ▪ Right and left ventricle ▪ 2 Atrioventricular valves (Mitral & Tricuspid) ▪ Open with ventricular diastole ▪ Close with ventricular systole ▪ 2 Semilunar Valves (Aortic & Pulmonic) ▪ Open with ventricular systole ▪ Open with ventricular diastole The Cardiovascular System ▪ Pulmonary Circulation ▪ Unoxygenated – right side of the heart ▪ Systemic Circulation ▪ Oxygenated – left side of the heart Anatomy Coronary Arteries How The Heart Works Anatomy Coronary Arteries ▪ 2 major vessels of the coronary circulation ▪ Left main coronary artery ▪ Left anterior descending and circumflex branches ▪ Right main coronary artery ▪ The left and right coronary arteries originate at the base of the aorta from openings called the coronary ostia behind the aortic valve leaflets. Physiology Blood Flow Unoxygenated blood flows from inferior and superior vena cava Right Atrium Tricuspid Valve Right Ventricle Pulmonic Valve Lungs Through Pulmonary system Physiology Blood Flow Oxygenated blood flows from the pulmonary veins Left Atrium Mitral Valve Left Ventricle Aortic Valve Systemic Circulation ▪ Blood Flow Through The Heart ▪ Cardiology Rap Physiology ▪ Cardiac cycle ▪ Represents the actual time sequence between
    [Show full text]
  • KNOW the FACTS ABOUT Heart Disease
    KNOW THE FACTS ABOUT Heart Disease What is heart disease? Having high cholesterol, high blood pressure, or diabetes also can increase Heart disease is the leading cause of your risk for heart disease. Ask your death in the United States. More than doctor about preventing or treating these 600,000 Americans die of heart disease medical conditions. each year. That’s one in every four deaths in this country.1 What are the signs and symptoms? The term “heart disease” refers to several The symptoms vary depending on the types of heart conditions. The most type of heart disease. For many people, common type is coronary artery disease, chest discomfort or a heart attack is the which can cause heart attack. Other first sign. kinds of heart disease may involve the Someone having a heart attack may valves in the heart, or the heart may not experience several symptoms, including: pump well and cause heart failure. Some people are born with heart disease. l Chest pain or discomfort that doesn’t go away after a few minutes. l Pain or discomfort in the jaw, neck, Are you at risk? or back. Anyone, including children, can l Weakness, light-headedness, nausea develop heart disease. It occurs when (feeling sick to your stomach), or a substance called plaque builds up in a cold sweat. your arteries. When this happens, your arteries can narrow over time, reducing l Pain or discomfort in the arms blood flow to the heart. or shoulder. Smoking, eating an unhealthy diet, and l Shortness of breath. not getting enough exercise all increase If you think that you or someone you your risk for having heart disease.
    [Show full text]
  • Chest Pain .Pdf
    Oklahoma State Department of Health 01-2018Revised CHEST PAIN/PRESSURE Cardiac and non-cardiac conditions cause chest pain including angina, myocardial infarction, hyperventilation, anxiety, muscle strain, pulmonary embolism or dissecting aortic aneurysm. History: Risk factors for heart disease Past history of heart attack Past history of angina; treatment Determine time of onset Quality of pain, sharp, dull, aching, stabbing, burning etc. Location of pain Severity of pain (0-10 scale) Additional symptoms; shortness of breath, unexplained sweating, nausea, radiating to arms, neck or back, rapid heart rate with shortness of breath, cough that may produce blood-streaked sputum, fainting, Anxiety or panic attacks Medications (Nitroglycerin) Medication Allergies (aspirin) Assessment: Obtain vital signs o Listen to heart-rate, rhythm, lungs (for breath sounds) o Check pulse in all extremities and compare Assess for: o Shortness of breath o Skin condition (cold, clammy, sweaty) o Pain with cough or deep breathing o Sudden difficulty speaking, loss of vision, weakness, or paralysis of one side of the body Treatment: If the person is standing, assist them to a sitting or lying position Loosen tight clothing Assist individual with prescribed nitroglycerin tablet. They should not bite or chew nitroglycerin. It should be placed under the tongue to dissolve. Prescribed nitroglycerin may be taken as 1 tablet or spray under the tongue every 5 minutes up to 3 tablets in 15 minutes Encourage individual to chew a 325mg uncoated aspirin Call EMS: Unexplained chest pain lasting more than a few minutes New cases of chest pain Unresolved pain after their normal treatment Pain associated with fever and shortness of breath Reference WebMD.
    [Show full text]
  • Education Heart Palpitations
    Education Heart Palpitations What are palpitations? Palpitations are an uncomfortable awareness of your heartbeat. You may feel that your heart is beating harder or faster than usual or that it is skipping a beat or two. Palpitations are common and often normal. They are a symptom, not a disease. However, it is important to determine their cause. How do they occur? Palpitations may be brought on by: exercise stress, anxiety, or fear smoking alcohol too much caffeine from coffee, colas, or tea anemia heart problems, such as mitral valve prolapse a thyroid problem medicines, such as diet pills and decongestants, or overdoses of such medicines as theophylline and antidepressants premenstrual syndrome (PMS) a lack of certain vitamins or minerals low blood sugar, or an insulin reaction in diabetics. What are the symptoms? Symptoms may include: thumping, pounding, or racing sensation in your chest fluttering sensation in your chest feeling of irregular beating or skipped beats. How are they diagnosed? Your health care provider will review your symptoms and examine you. You may have an electrocardiogram (ECG) or other tests to help find the cause. You may be given a heart monitor to wear at home. You may have an ultrasound test of the heart called an echocardiogram or an exercise stress test to see if heart problems are causing the palpitations. How are they treated? Treatment of palpitations depends on the cause. Most often, no treatment is needed because the heart is otherwise normal. Drinking less coffee or alcohol, or none at all, may be all you need to do.
    [Show full text]